The mental health impact of vaping continues to take a backseat to concerns over the physical effects.
Nicotine: The Biological Explanation
Nicotine impacts the brain and other parts of the nervous system. Pulmonary absorption happens in mere seconds. Approximately seven seconds after inhaling nicotine, it crosses the blood-brain barrier.
In the brain, nicotine binds to acetylcholine receptors (nAChRs) as well as cholinergic receptors in the autonomic ganglia, adrenal medulla, chemoreceptors of the carotid bodies, aortic body, and neuromuscular junction.
Here is a snapshot of what happens in your brain seven seconds after nicotine consumption.
- The adrenal glands are stimulated, epinephrine is discharged, and blood pressure rises
- A sudden release of glucose causes an increase in respiration, heart rate, constriction of arteries, and alertness
- The central nAChR receptors are stimulated, there is a burst of dopamine, and you quickly experience the psychoactive rewards of nicotine
In short, nicotine has a wide and varied impact on the brain, causing a cluster of positive and negative effects.
How Nicotine Impacts the Central Nervous System
Nicotine also acts as both a stimulant and a depressant in the central nervous system. When dopaminergic receptors are stimulated in the nervous system, they release acetylcholine, norepinephrine, dopamine, serotonin, vasopressin, growth hormones, and ACTH.
Additionally, the circulating levels of norepinephrine and epinephrine increase and the bioavailability of dopamine is altered. Arginine vasopressin is released, as well as beta-endorphin, adrenocorticotropic hormone, and cortisol.
Several of these chemicals are psychoactive, leading to immediate positive behavioral effects.
- Norepinephrine increases alertness, arousal, and attention
- Serotonin creates a long-lasting feeling of happiness or well-being
- Vasopressin boosts social behaviors such as pair bonding and social recognition
Of course, the positives must be weighed against the negative long-term mental health effects of consuming nicotine.
Long-Term Mental Health Impact Of Vaping
While conversations about the physical health impact of nicotine continue to take center stage, the question of just how much nicotine impacts mental health has taken a backseat.
And, in this already niche field of interest, much of the existing literature and research focuses on traditional cigarettes. Many of those studies center around one of the most popular areas of research into nicotine consumption; the effects on young people.
The scope of the research into the mental health impact of vaping is narrow at best, but academics are constantly publishing novel research that solidifies the connection between e-cigarette consumption and mental health.
Overall Psychological Impact Of Vaping
In the scientific community, the consensus is that “nicotine dependence shows high comorbidity with many mental illnesses including but not limited to, attention deficit hyperactivity disorder, anxiety disorders, and depression.” The same review speculated that nicotine dependence is a comorbidity for many mental illnesses because people with mental health issues are more likely to self-medicate.
Besides all the negative outcomes associated with vaping, there are also many positives, the most well-known one being the release of dopamine. Dopamine triggers positive feelings, which might explain why e-cigarette use is more common among people with clinical depression.
Vaping and Depression
One study analyzed data from 892,394 participants to ascertain the prevalence of self–reported depression among Americans who use e-cigarettes.
- Former e-cigarette users had 1.6 times higher odds of reporting a history of clinical diagnosis of depression than never-users
- Current e-cigarette users had 2.1 times higher odds of reporting a history of clinical diagnosis of depression than never-users
- Former e-cigarette users had 1.52 times higher odds of reporting at least one day of poor mental health in the past month compared to never-users who reported no days of poor mental health
Similar results were found regardless of sex, race/ethnicity, smoking status, and student status. The study concluded that there is a “significant cross-sectional association between e-cigarette use and depression” which emphasizes the need for studies analyzing the long-term risk of depression among e-cigarette users.
These findings are reflected in other studies, especially those focused on adolescents in the U.S. One study assessed baseline depressive symptoms in 2,460 adolescents who had never used combustible cigarettes or e-cigarettes. Researchers assessed the adolescents again at two separate follow-up sessions spaced 6 months apart.
- Sustained use of e-cigarettes over the 12-month observation period was associated with higher depressive symptoms compared to non-use
- Among those who reported sustained use of e-cigarettes, there was a higher frequency of depressive symptoms at the final follow-up
In short, researchers found an association between depressive symptoms and e-cigarette use among adolescents. The average age of the participants was 14.1, adding fuel to the ever-growing concerns over adolescent uptake of e-cigarettes.
Vaping and Eating Disorders
As far back as the 1980s, researchers have shown that cigarettes act as appetite suppressants.
One seminal study assessed the weight of 12,103 American men and women between 19 and 74 years of age. Researchers collected data via the Second National Health and Nutrition Examination Survey and found the following:
- Cigarette smokers weighed less and were leaner than non-smokers
- Body leanness increased with the duration (but not intensity) of smoking
Following these findings, researchers sought to prove that nicotine was the main appetite suppressant in tobacco. Researchers found that nicotine affects appetite regulation, with several studies also showing that nicotine administration suppresses food intake in animals.
With these building blocks firmly established, researchers turned their attention to the mental health effects of ingesting known appetite suppressants. Eating disorders, which have long been considered to be mental health conditions, entered the spotlight.
One study used cross-sectional data from the 2018-2019 Healthy Minds Study, which analyzed self-reported lifetime eating disorder diagnosis and risk among college students. Self-reported lifetime eating disorders included anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Here are the findings:
- Vaping or e-cigarette use was associated with higher odds of all eating disorder measures, including the self-reported lifetime eating disorders
- Vaping or e-cigarette use was associated with a higher risk of developing an eating disorder
Another study assessed the link between vaping and attitudes/behaviors associated with eating disorders in adolescent girls. 299 girls between the ages of 13 and 17 were asked to complete a REDCap survey.
- Electronic Cigarette Dependence Index (ECDI) scores were correlated with weight preoccupation, binge eating, and compensatory behavior, but not body dissatisfaction
Despite these findings, researchers are still at a loss to explain why exactly nicotine acts as an appetite suppressant. One review concluded that nicotine targets central neurons and increases energy expenditure, but this is just one of the explanations in the scientific community. It is also thought that ingesting nicotine in the form of traditional cigarettes and e-cigarettes acts as a behavioral alternative to eating, creating a distraction from actual hunger.
Vaping and Sleep Quality
Vaping aside, it is well known that nicotine impacts sleep health. Nicotine is a stimulant and can disrupt neurotransmitters involved in the processes of sleep.
Although the research into the area of e-cigarettes and sleep is minimal, recent articles establish a link between vaping and poor sleep quality. One study assessed the sleep quality among 316 participants aged 18 to 25. Some of the participants vaped, and others were non-vapers who had never used e-cigarettes before. Using the Pittsburgh Sleep Quality Index (PSQI), researchers found that:
- Vapers were more likely to be evening types
- Vapers had significantly lower sleep quality
- Vapers had significantly higher anxiety symptoms
This novel research is one of the first attempts at discovering how nicotine, especially nicotine from vape devices, impacts sleep.
Dr Simon L. Evans, one of the researchers behind the study and a Lecturer in Neuroscience at the University of Surrey in England, said, “Vaping impacts all areas of physical and mental health. Poor sleep not only affects a young person’s daily functioning but, over the long term, increases the risk of developing heart disease and diabetes. In this study, we found a disturbing link between vape use and anxiety symptoms, and it can become a vicious cycle of using a vape to soothe anxiety but then being unable to sleep, making you feel worse in the long run.”
Vaping and Suicidal Ideation Among Adolescents
Suicide might seem the least likely effect of continued e-cigarette use, but studies have shown a tentative link between the two.
Using data from the 2015 and 2017 waves of the Youth Risk Behavior Survey, researchers found that e-cigarette-only use was associated with higher odds of reported suicidal ideation compared to non-users. However, the study also stated that the same result was observed among participants who only used marijuana.
Similarly, an analysis of 11,313 adolescents from the 2015 Korean Youth Risk Behaviour Web-Based Survey found that a significant number of participants who used e-cigarettes within the last 12 months experienced “sadness and hopelessness” as well as an increased number of suicidal plans and suicide attempts compared to non-users.
These findings are mirrored in a 2019 article that used from the 2016 Korean Youth Risk Behavior Web-Based Survey. This time, researchers analyzed responses from 5,405 middle and high school students aged 13 to 18 years. Among those who used e-cigarettes for 1 to 30 days in the past 30 days, suicidal ideation, suicidal plans, suicidal attempts, and serious attempts, were higher than those who did not use e-cigarettes in the past 30 days.
Although the research suggests a strong connection between e-cigarette use and suicidal ideation among adolescents, there is no evidence that this is a result of e-cigarettes rather than behavioral or other factors.
Final Thoughts
Researchers have established links between e-cigarette use and a number of psychological conditions, including, but not limited to, depression, sleep health, eating disorders, and even suicidal ideation.
In these cases, “e-cigarette use” can be defined as nicotine use; researchers have yet to conclusively prove that another ingredient in e-liquids (or even e-cigarettes) causes adverse mental health effects. There is much speculation about the invisible ingredients, with some suggesting that trace amounts of metals found in e-liquids and e-cigarettes could cause psychological reactions.
Amid speculation, the debate over whether vaping is responsible for or a symptom of mental health conditions wages on. Given the relative lack of research into e-cigarettes as a whole, I wouldn’t be surprised to hear the same debate for decades to come.
For now, we need to zoom out and bring mental health conversations to the forefront of the vaping discourse. Politicians, researchers, and concerned parties who claim to worry about the physical health impact of vaping among adolescents have yet to hone in on the very real mental health issues that plague young vapers.
